The Burkitt-like lymphomas: a Southwest Oncology Group study delineating phenotypic, genotypic, and clinical features

Abstract

The Revised European-American Lymphoma classification gives Burkitt-like lymphoma (BLL) provisional status, leaving unresolved the differential diagnosis with Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL). This study compared the biologic features of adult BLL and DLBCL. The phenotypic distinction between BLL and DLBCL was determined by immunohistochemical staining of frozen tissue from 13 patients with BLL and 55 patients with DLBCL by using an extensive antibody panel including Ki-67, CD10, CD11a/lymphocyte function-associated antigen 1␣ (LFA-1␣), CD18/LFA-1␤, CD58/LFA-3, and CD54/ intercellular adhesion molecule, CD8 for tumor-infiltrating cytotoxic T cells (TTILs), CD44 homing receptor, and p53 and Bcl-2 oncogenic proteins. Compared with DLBCL, BLL had a higher proliferative rate (mean Ki-67, 88% versus 53%), greater expression of CD10 and p53 antigens, and decreased expression of Bcl-2. BLL cases had a consistent absence of one or more cell adhesion molecules (92% versus 27%), low T-TIL numbers, and absence of CD44 homing receptor (92% versus 14%). The t(8;14) translocation was identified in 80% of BLL cases, but no patients with BLL had the t(14;18) translocation. In a 10-year analysis, median survival of patients with BLL was 1.2 years, and that of patients with DLBCL was 2.5 years. Although the proportion of patients cured was similar in the 2 groups, BLL patients had an increased risk of early death. We conclude that BLL can be recognized by its combined morphologic and phenotypic features and that it represents a high-grade lymphoma much closer to BL than DLBCL. Retention of the BLL category or inclusion of BLL as a variant of BL is biologically and clinically more appropriate than absorbing the category of BLL into DLBCL. (Blood. 2001; 97:3713-3720)

Simple karyotype and bcl-6 expression predict a diagnosis of Burkitt lymphoma and better survival in IG-MYC rearranged high-grade B-cell lymphomas

“…4,7,24 Three of six unclassifiable cases in this study harbored such dual translocations. The fourth such case was a diffuse large B-cell lymphoma.…”

“…1 However, these rearrangements are not entirely specific as they are also seen occasionally in other high-grade B-cell lymphomas, [2][3][4][5][6][7] including those in the newly proposed entity 'B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma' (hereafter referred to as unclassifiable B-cell lymphoma) in the 2008 World Health Organization (WHO) classification of tumors of hematopoietic and lymphoid tissue. 8 Furthermore, MYC rearrangements are often accompanied by varying numbers of additional cytogenetic abnormalities.…”

Translocations involving 8q24 in Burkitt lymphoma and other malignant lymphomas: a historical review of cytogenetics in the light of todays knowledge

“…[16][17][18] As this distinction may be difficult using the current diagnostic tools, 19 several groups have focused on new parameters. [19][20][21][22][23][24] Recently, two comprehensive gene-expression studies on the subject have been published, showing some differences in outcome. In both studies, BL could be distinguished from other aggressive lymphomas by a distinctive gene expression pattern, that is, the combination of expression levels of multiple genes being able to predict a diagnosis of BL (predictor or index).…”

Short intensive sequential therapy followed by autologous stem cell transplantation in adult Burkitt, Burkitt-like and lymphoblastic lymphoma

“…In addition, it has been argued that as BLL represents a high-grade aggressive lymphoma much closer to BL than DLBCL, inclusion of BLL as a variant of BL is biologically and clinically more appropriate than absorbing the category of BLL into DLBCL. 29 Thus, until now, tumor morphology and immuno-phenotype have been used as main diagnostic criteria for patient entry in prospective clinical studies on BL and we are not aware of clinical studies prospectively based on inclusion of only MYC/8q24 positive cases. Although considered to be the pathogno-monic hallmark of BL, MYC/8q24 breakpoints are not exclusively found in BL but can also be detected in some morphologically undisputed cases of DLBCL.…”